Authors : Dimba Marmo; Eveline Mboh Khan; Atanga D. Funwie; Foyeth Eugene

Volume/Issue : Volume 11 - 2026, Issue 1 - January

Google Scholar : https://tinyurl.com/34beuh8x

Scribd : https://tinyurl.com/yxduad6v

DOI : https://doi.org/10.38124/ijisrt/26jan1071

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Abstract : Background: Immunization is one of the most effective public health interventions, yet coverage remains critically low in fragile districts of Cameroon’s Far North region. Insecurity, displacement, and sociocultural barriers contribute to persistent gaps, leaving many children vulnerable to vaccine preventable diseases.  Objective: To assess the prevalence and determinants of zero-dose and under-immunization among children aged 12–35 months in fragile districts of the Far North region of Cameroon.  Methods: A quantitative descriptive cross-sectional study was conducted between December 2024 and August 2025. Using multistage random sampling, 383 mothers/guardians of eligible children were interviewed across 25 missed communities. Data were collected through a structured, pre tested questionnaire and analyzed using descriptive statistics and logistic regression. Dependent variables were zero dose (no DTP1) and under immunization (missed DTP3 or other vaccines).  Results: Only 27% of respondents presented a vaccination card, and just 21% of children were fully vaccinated against EPI diseases. The burden of missed immunization was extremely high: 51% of children were zero dose and 35% under immunized, meaning 87% were either zero dose or under immunized. Although 48% had received RR doses, this partial progress was insufficient to close the coverage gap. Females were disproportionately affected, with 29% never receiving DTP1 compared to 19% of males. Logistic regression identified several significant determinants: maternal education (AOR = 2.45, 95% CI: 1.30–4.62, p = 0.005), maternal autonomy (AOR = 0.62, 95% CI: 0.40–0.95, p = 0.03), household wealth (AOR = 1.85, 95% CI: 1.10–3.12, p = 0.02), geographic barriers such as conflict affected or remote areas (AOR = 3.10, 95% CI: 1.75–5.50, p < 0.001), and supply side constraints including vaccine stock outs (AOR = 2.20, 95% CI: 1.25–3.90, p = 0.006) and lack of trained staff (AOR = 1.70, 95% CI: 1.05–2.75, p = 0.03). Cultural attitudes such as refusal of male vaccinators, lack of trust in health personnel, and religious restrictions were also independently associated with under immunization (p < 0.05).  Conclusion: Zero-dose and under-immunization remain alarmingly prevalent in fragile districts of Cameroon, with 87% of children affected. Inferential analysis confirms that maternal education, autonomy, household wealth, geographic insecurity, and health system constraints are statistically significant determinants. Addressing these barriers through targeted, context-specific interventions is urgently needed to strengthen immunization coverage in fragile settings.

Keywords : Zero-Dose, Unimmunized, Poor Immunization Coverage, Children, Missed Communities, Fragile Health Districts.

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